- A 66-year old retired African American male presents with reduced urinary flow and hematuria.
- PMH: High blood pressure. Currently taking enalapril 10 mg.
- FHx: Father lung cancer age 74.
- Patient walks 3 miles a day.
- PSA 9.8 ng/ml
- Prostate biopsy shows Gleason 7 (4+3) prostate cancer
- Undergoes robotic-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection (PLND)
- Results show:
- pT3b (focal extracapsular extension and seminal vesicle invasion) margins negative
- Post-operative PSA=0.64 ng/ml
- Patient undergoes adjuvant radiation therapy and is started on leuprolide acetate.
- PSA drops to undetectable levels
- PSA starts to rise to 0.3 ng/ml
- Repeated 3 months later 0.7 ng/ml
- Bone scan and prostate-specific membrane antigen (PSMA) scan both negative
- Diagnosis nonmetastatic castration-resistant prostate cancer (CRPC)
- Patient declines additional therapy at this time
- PSA continues to rise over the next 18 months going up to 9.8 ng/ml
- Bone scan shows lesion in the left superior pubic ramus
- Patient is asymptomatic